The use of cardiopulmonary exercise testing in pediatrics provides critical insights into potential physiological causes of unexplained exercise-related complaints or symptoms, as well as specific pathophysiological patterns based on physiological responses or abnormalities. Clinical interpretation of the results of a cardiopulmonary exercise test in pediatrics requires specific knowledge with regard to pathophysiological responses and interpretative strategies that can be adapted to address concerns specific to the child’s medical condition or disability. In this review, the authors outline the 7-step interpretative approach that they apply in their outpatient clinic for diagnostic, prognostic, and evaluative purposes. This approach allows the pediatric clinician to interpret cardiopulmonary exercise testing results in a systematic order to support their physiological reasoning and clinical decision making.
Marco Van Brussel, Bart C. Bongers, Erik H.J. Hulzebos, Marcella Burghard, and Tim Takken
Bart C. Bongers, Erik H.J. Hulzebos, Bert G.M. Arets, and Tim Takken
Purpose: The oxygen uptake efficiency slope (OUES) has been proposed as an ‘effort-independent’ measure of cardiopulmonary exercise capacity, which could be used as an alternative measurement for peak oxygen uptake (VO2peak) in populations unable or unwilling to perform maximal exercise. The aim of the current study was to investigate the validity of the OUES in children with cystic fibrosis (CF). Methods: Exercise data of 22 children with CF and mild to moderate airflow obstruction were analyzed and compared with exercise data of 22 healthy children. The OUES was calculated using data up to three different relative exercise intensities, namely 50%, 75%, and 100% of the total exercise duration, and normalized for body surface area (BSA). Results: Only the OUES/BSA using the first 50% of the total exercise duration was significantly different between the groups. OUES/BSA values determined at different exercise intensities differed significantly within patients with CF and correlated only moderately with VO2peak and the ventilatory threshold. Conclusion: The OUES is not a valid submaximal measure of cardiopulmonary exercise capacity in children with mild to moderate CF, due to its limited distinguishing properties, its nonlinearity throughout progressive exercise, and its moderate correlation with VO2peak and the ventilatory threshold.
Bart C. Bongers, Maarten S. Werkman, Donna Blokland, Maria J.C. Eijsermans, Patrick van der Torre, Bart Bartels, Olaf Verschuren, and Tim Takken
To determine criterion validity of the pediatric running-based anaerobic sprint test (RAST) as a nonsophisticated field test for evaluating anaerobic performance in healthy children and adolescents.
Data from 65 healthy children (28 boys and 37 girls between 6 and 18 years of age, mean ± SD age: 10.0 ± 2.8 years) who completed both the pediatric RAST and the 30-s Wingate anaerobic test (WAnT) on a cycle ergometer in a randomized order were analyzed. Peak power (PP) and mean power (MP) were the primary outcome measures for both tests.
There were no significant sex-differences in PP and MP attained at the pediatric RAST and the WAnT. Age was strongly correlated to pediatric RAST and WAnT performance (Spearman’s rho values ranging from 0.85 to 0.90, with p < .001 for all coefficients). We found high correlation coefficients between pediatric RAST performance and WAnT performance for both PP (Spearman’s rho: 0.86; p < .001) and MP (Spearman’s rho: 0.91; p < .001).
The pediatric RAST can be used as a valid and nonsophisticated field test for the assessment of anaerobic performance in healthy children and adolescents. For clinical evaluative purposes, we suggest to use MP of the pediatric RAST when assessing glycolytic power in the absence of the WAnT.
Moniek Akkerman, Marco van Brussel, Bart C. Bongers, Erik H.J. Hulzebos, Paul J.M Helders, and Tim Takken
The objective of this study was to investigate the characteristics of the submaximal Oxygen Uptake Efficiency Slope (OUES) in a healthy pediatric population. Bicycle ergometry exercise tests with gas-analyses were performed in 46 healthy children aged 7–17 years. Maximal OUES, submaximal OUES, V̇O2peak, VEpeak, and ventilatory threshold (VT) were determined. The submaximal OUES correlated highly with V̇O2peak, VEpeak, and VT. Strong correlations were found with basic anthropometric variables. The submaximal OUES could provide an objective, independent measure of cardiorespiratory function in children, reflecting efficiency of ventilation. We recommend expressing OUES values relative to Body Surface Area (BSA) or Fat Free Mass (FFM).